Treating cancer-associated venous thromboembolism: A practical approach.

Venous thromboembolism (VTE) is a common and potentially life-threatening complication in patients with cancer. Both cancer and its treatments increase the risk of developing VTE. Specific cancer types and individual patient comorbidities increase the risk of developing cancer-associated VTE, and the risk of bleeding is increased with anticoagulation therapies. The aims of this article are to summarize the latest evidence for treating cancer-associated VTE, discuss the practical considerations involved, and share best practices for VTE treatment in patients with cancer. The article pays particular attention to challenging contexts including patients with brain, lung, gastrointestinal, and genitourinary tumors and those with hematological malignancies. Furthermore, the article summarizes specific clinical scenarios that require additional treatment considerations, including extremes of body weight, nausea and gastrointestinal disturbances, compromised renal function, and anemia, and touches upon the relevance of drug-drug interactions. Historically, vitamin K antagonists and low-molecular-weight heparins (LMWHs) have been used as therapy for cancer-associated VTE. The development of direct oral anticoagulants has provided additional treatment options, which, in certain instances, offer advantages over LMWHs. There are numerous factors that need to be considered when treating cancer-associated VTE, and although various treatment guidelines are helpful, they do not reflect each unique scenario that may arise in clinical practice. This article provides a summary of the latest evidence and a practical approach for treating cancer-associated VTE.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: EVC: provided consultancy services to AbbVie, Agenus, ALX, Amgen, Arcus Biosciences, Astellas, AstraZeneca, Bayer, Beigene, Bexon Clinical, BioNTech, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Debiopharma, Elmedix, EISAI, Galapagos, GlaxoSmithKline, Hookipa Biotech, Incyte, Ipsen, Lilly, Merck Sharp & Dohme, Merck KGaA, Mirati, Novartis, Nordic, Pierre Fabre, Pfizer, Roche, Seattle Genetics, Servier, Simcere, Takeda, Taiho, and Terumo. IM: received grant/research support from Bristol Myers Squibb/Pfizer; and received honoraria and travel/meeting support from Bristol Myers Squibb, Pfizer, and Leo Pharma. EF: participated on advisory boards for AbbVie, Amgen, AstraZeneca, Bayer, Beigene, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, F. Hoffmann-La Roche, Gilead, GlaxoSmithKline, Janssen, Merck Serono, Merck Sharp & Dohme, Novartis, Peptomyc, Pfizer, Regeneron, Sanofi, Takeda, Turning Point, and Daiichi Sankyo; received honoraria from Amgen, AstraZeneca, Bristol Myers Squibb, Daiichi Sankyo, Eli Lilly, F. Hoffmann-La Roche, Genentech, Janssen, Medical Trends, Medscape, Merck Serono, Merck Sharp & Dohme, Peervoice, Pfizer, Sanofi, Takeda, and Touch Oncology; received meeting/travel support from AstraZeneca, Janssen, and Roche; and is an independent member of the eboard of Grifols. GA: nothing to disclose. AA: received grant/research support from Bristol Myers Squibb and Roche; received honoraria from Amgen, AstraZeneca, Bayer, Daiichi, EISAI, Genomic Health, Ipsen, Leo Pharma, Lilly, Merck, MSD, Novartis, Pfizer, and Seattle Genetics; and participated on a Data Safety Monitoring Board or advisory board for Amgen, AstraZeneca, Bayer, Daiichi, EISAI, Genomic Health, Hengrui, Innate, Ipsen, Leo Pharma, Lilly, Merck, MSD, Novartis, Pfizer, Seattle Genetics, and Menarini. AC: received research support from AstraZeneca, Bayer, Bristol Myers Squibb, Daiichi-Sankyo, Pfizer Limited, and Sanofi; provided consultancy services to Alexion, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Centrix Healthcare, Daiichi-Sankyo, Pfizer Limited, and Sanofi; received honoraria from AstraZeneca, Bayer, Bristol Myers Squibb, Centrix Healthcare, Daiichi-Sankyo, Pfizer Limited, and Sanofi; received meeting/travel support from AstraZeneca, Bayer, Bristol Myers Squibb, Centrix Healthcare, Daiichi-Sankyo, Pfizer Limited, and Sanofi; and participated on a Data Safety Monitoring Board or advisory board for AbbVie, AstraZeneca, Bayer, Bristol Myers Squibb, Daiichi-Sankyo, and Pfizer Limited. AF: received honoraria from Sanofi, Leo Pharma, and Werfen. MM: nothing to disclose. MP: nothing to disclose. NT: received honoraria from Vianex; and received meeting/travel support from Leo Pharma. PV: received research funding from Bayer, Bristol Myers Squibb, Pfizer, and Leo Pharma; and received honoraria from Bayer, Pfizer, Bristol Myers Squibb, Daiichi-Sankyo, Leo Pharma, and Anthos Therapeutics. CA: received manuscript development support from Bristol Myers Squibb/Pfizer; and provided consultancy services to and received honoraria from Bayer, Bristol Myers Squibb/Pfizer, Daiichi-Sankyo, and Sanofi.
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